- 1912-1978 (Creation)
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The York Tuberculosis Dispensary, situated in a converted private house at Castlegate, York, was opened on 12 December 1912 as the central point of York' Corporation's anti-tuberculosis scheme. The elements of this scheme were typical of those employed in other towns and cities and were part of a national campaign against TB which began just before the turn of the century.
Death rates from phthisis (pulmonary TB) constituted between 7 and 8% of total annual deaths in the city around 1900; death rates from all forms of TB were about 12% of total annual deaths.
A local system of voluntary notification in York of cases of phthisis-with-expectoration was begun in 1902. Cases notified by GPs and cases from the sub-registrar's death returns were investigated by the Medical Officer of Health and his staff. A campaign of publicity and advice was also commenced, with leaflets, notices against spitting in public places, and advice to individual victims and their families. Disinfection and cleansing of TB sufferers' houses was done by the Health Department.
However, Dr E.M. Smith, the Medical Officer of Health, reported in 1907 that many difficulties remained. Only a limited amount could be achieved while notification remained voluntary and there were many unsolved problems which dogged the campaign: the underlying problems of bad housing, poverty, the need for pure milk and meat and for isolation hospitals and sanatoria to accommodate TB patients. He called for legislation to make notification compulsory, for the abolition of damp, ill ventilated houses, the eradication of bovine TB, and better instruction and education. Such sentiments were typical of the views voiced by Medical Officers of Health and public health reformers during this period.
In 1908, Local Government Board Regulations were issued making it compulsory for Poor Law Boards of Guardians to notify Medical Officers of Health of cases of TB occurring in poor law institutions. The Public Health (Tuberculosis in Hospitals) Regulations of 1911 made notification of cases in hospitals compulsory. These paved the way for compulsory notification of phthisis under the Public Health (Tuberculosis) Regulations of 1911, and the compulsory notification of all forms of TB under the regulations which followed in 1912.
The local campaign, meanwhile, developed in various ways between 1907 and 1912. A report by the MOH on measures for the further prevention of TB was being considered by the Health Committee's Prevention of Consumption Sub-Committee in 1910. TB schemes at Sheffield and Rotherham were visited and inspected, while the MOH visited the Tuberculosis Dispensary at Edinburgh and the Leeds Sanatorium at Gateforth. A week-long TB exhibition in York in November 1910 generated great interest: over 27.000 people attended and a programme of demonstrations and lectures was included.
In 1912 a local scheme was devised for the city which embodied the suggestions in the recently issued Interim or 'Astor' Report of the Departmental Committee on Tuberculosis. The local scheme was further developed over the next few years and included hospital and sanatorium provision as well as a central TB Dispensary to co-ordinate strategy.
As a first step, an open-air ward with eight beds for the observation and instruction of early phthisis cases was erected at the Fever Hospital at Yearsley Bridge. This was opened for patients, after considerable delays in building, on 25 January 1912. Meanwhile, suitable premises for a sanatorium were sought, and it was initially hoped to combine with the North and East Ridings County Councils and other county boroughs for this purpose. A small number of hospital beds for TB patients requiring surgical treatment were reserved at the York County Hospital. In 1912 a York Tuberculosis Officer was appointed to co-ordinate the tuberculosis scheme. Finally, at the end of the year the Tuberculosis Dispensary was opened.
The house on Castlegate where the TB Dispensary was accommodated had recently been purchased along with Castlegate School by the York Education Authority, and it was rented from the latter by the Health Committee. Its central situation was noted as being very convenient, and it was accessible by electric tram even from the most distant parts of the city. The suite of rooms consisted of a large sitting room, a consulting room with two dressing rooms, a doctor's room, and a room for a secretary and a nurse. Necessary equipment was bought, including apparatus for the administration of tuberculin, an electric lamp for laryngoscopic examinations, and filing cabinets for records of cases. X-Ray apparatus was ordered in 1914. Bacteriological work was carried out at the Health Department Laboratory (later at the Yorkshire Pathological Laboratory at Leeds). An experienced woman, Miss Elizabeth E. Coning, was appointed as Secretary to the Dispensary. Miss Coning was an Associate of the Royal Sanitary Institute and had been the Health Visitor of the York Health and Housing Reform Association, so she already had a wide knowledge and experience of tuberculosis in the city. As Secretary, she assisted the Tuberculosis Officer, visited patients in connection with the after-care work of the Dispensary, and kept detailed records.
The work of the Dispensary, which was central to the whole TB scheme, was to investigate the history and treatment of cases; to investigate and improve home conditions; to provide help and advice; to examine not only TB victims but also their contacts; to administer tuberculin and other treatments; to observe cases still in employment; and to provide after-care of TB patients. Or in other words, as the TB Officer noted in 1913 the Dispensary acted as a receiving house and centre of diagnosis; a clearing house and centre of observation; a centre for curative treatment; a centre for examination of contacts; an information bureau and a centre for guidance of after-care. While the Health Department continued to co-ordinate sanitary inspection and disinfection, all personal work was concentrated at the Dispensary, and referrals for treatment or care at sanatoria were made from there.
Very detailed records of TB cases were apparently kept (and it is thus all the more unfortunate that none of these records now survive). Five different forms were filled in. Form A gave full details of illness and previous treatment, with a summary of clinical details; Form B was a record of the physical condition of the patient on admission; Forms C and D were records of special treatments and the progress of the case; and Form E was a record of home conditions and patients' everyday life including details of household and housing conditions, details of which were also extracted for Health Department files. A street index of cases and an occupation index were also maintained.
From 1912 onwards, the TB scheme was further refined. A small open-air class for about 20 tuberculous children was held in the garden behind the TB Dispensary, under the auspices of the School Medical Officer; this was transferred to a large hut in the grounds of Fulford Field House in 1921. The Poor Law Workhouse wards were initially used for advanced TB cases; later these were accommodated at Fairfield Sanatorium and at the Fever Hospital. Tuberculous out-patients, meanwhile, were regularly treated at York County Hospital and by the York Dispensary in Duncombe Place.
The Health Committee's Prevention of Consumption Sub-Committee was renamed the Tuberculosis Sub Committee in 1912, and this oversaw the detailed management of the TB scheme. In 1913 a voluntary after-care committee was organised by the York Health and Housing Reform Association, with representatives of the Tuberculosis Sub-Committee and other interested bodies. This was known as the Tuberculosis Crusade Committee and its task, under the direction of the TB Dispensary, was to help patients and families with financial and other assistance, including financial maintenance for those unable to work, the loan of TB shelters and bedding, the provision of milk and other nourishment, and visiting and advice. In some cases children were boarded out and healthier accommodation sought for families. A 'Flower Crusade', through which flowers were sold to raise funds, was held each year.
In 1914, after many years of efforts to find sanatorium premises, agreement was reached with the East Riding County Council to establish a joint sanatorium at Raywell House, near Cottingham in the East Riding. The scheme was subsequently delayed by the First World War, while at the same time a pressing need arose to accommodate discharged tuberculous soldiers. The Corporation thus looked for further sanatorium accommodation, and opened its own Fairfield Sanatorium in 1919. Raywell Sanatorium eventually opened in 1920. After the opening of these two hospitals, the TB accommodation at the Fever Hospital at Yearsley Bridge was adjusted to accommodate females only.
The Tuberculosis Dispensary was dealing with between 300 and 400 new cases of TB each year in the First World War period. In 1915, for example, there were 408 new cases, 6,909 attendances at the Dispensary, and 2,421 visits paid to patients' homes. Numbers dropped to between 200 and 350 new cases annually in the early 1920s. In 1925, for example, there were 1,328 persons on the Dispensary register (ie old and new cases), and there had been 3,759 attendances, with 2,975 visits to patients' homes. Mortality from TB was lower by the early 1920s: deaths from TB in the city were just under 100 per year (about 70 of these from pulmonary TB), which represented a drop by about a third from figures at the turn of the century.
The decline continued during the 1930s and 1940s: in 1935 there were only 515 persons on the Dispensary register. There were between 50 and 60 deaths annually from TB in York during the late 1930s (including around 40 to 50 deaths from pulmonary TB), and annual notifications to the Medical Officer of Health had dropped to between 70 and 90 each year, compared to between 200 and 300 during the First World War period. The TB scheme, the generally better economic and social conditions, and not least the large scale slum clearance and council house building in the 1930s no doubt all played their part in a decline which was also experienced nationally.
There was little general change in the essential work of the Dispensary over the years. However, there was increasing liaison with other institutions. For example, X-Ray and light treatment facilities at the York County Hospital were drawn on, as were the services of its orthopaedic consultants. From 1934 onwards the Health Committee paid the County Hospital ,1000 per year to treat indoor and outdoor TB patients. Hospital facilities elsewhere were also utilised: including Leeds General Infirmary for light treatment, as well as sanatorium accommodation at institutions outside York. The opening of the Corporation's City General Hospital in 1941 offered new resources: City Hospital thereafter undertook all X-Ray examinations for the Dispensary in addition to some of the surgical work on TB cases. A Contact and Chest Diagnosis Clinic was held there weekly from October 1944, while an artificial pneumothorax clinic treated TB patients by collapse therapy.
From 1937 onwards, separately run clinic sessions were held at the York TB Dispensary premises for North Riding patients; from 1944 separate clinic sessions were also held for East Riding patients.
In 1948, York TB Dispensary, along with Fairfield Sanatorium, was taken over by York 'A' Group Hospital Management Committee. It was renamed the Chest Clinic, York (but also often called the TB Clinic or Castlegate Chest Clinic). The advent of the NHS split responsibility for TB care between the health service and local authorities, the former managing hospitals and related services and the latter having responsibility for domiciliary and after-care. But there was much co-ordination after 1948, and the Chest Clinic remained the centre of the city's TB service. The after-care work for which York Corporation was responsible continued to be delegated to the voluntary York Tuberculosis Committee (the term 'Crusade' was dropped from its title in 1950). One significant change after 1948 was the setting up of a Central Administrative Bureau in Hull for regional hospital admissions for TB. This meant that Fairfield Sanatorium, which had previously served the city now took only a proportion of York patients, and the waiting list in the city initially lengthened. It also meant that York patients were admitted to a wider range of sanatoria in Yorkshire.
As York 'A' Group Hospital Management Committee rationalised services at its various hospitals and premises, X-ray chest screening work and the artificial pneumothorax clinic were relocated from City Hospital to the York Chest Clinic in 1954. The Clinic continued to be busy in the early 1950s: in 1954 attendances numbered 3,130 while in 1955, after the transfer of the above services, attendances increased to 4,532.
The 1950s saw the advent of new drugs to combat TB, and new strategies to deal with the remaining problem. There was regular mass radiography, and the routine BCG vaccination of schoolchildren was introduced in 1955. The York Medical Officer of Health noted in 1957 that the 53 notifications of TB to the Health Department that year were nor only the lowest on record but also less than 50% of the number notified ten years earlier.
The change of name, from Tuberculosis Dispensary to Chest Clinic in 1948 was symbolic of contemporary changes: as TB declined, attention was turning to other diseases of the chest. Former tuberculosis sanatoria became hospitals for general chest diseases. The York Tuberculosis Committee changed its name to the York Chest and Heart Association, in the wake of the renaming of the National Association for the Prevention of TB as the Chest and Heart Association in 1958. By the late 1950s the York Chest and Heart Association dealt with very few requests for help in TB cases and it began to aid sufferers from lung cancer, asthma and heart diseases.
In 1962, for the first year since records had been kept, there were no York deaths from respiratory TB. Numbers notified to the MOH, as well as numbers treated at the Chest Clinic, continued to decline in the 1960s and early 1970s. For example, in 1972 the York MOH's annual report noted that only 71 new cases were investigated that year at the Chest Clinic and only 8 of these were found to be tuberculous. There were 873 attendances at the Clinic that year and only 374 visits to patients by staff.
In 1974 responsibility for the Clinic passed to York Health District, in North Yorkshire Area Health Authority. It was closed on 5 August 1976.
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